"President Donald Trump last year hailed a multibillion-dollar initiative to create a seamless digital health system for active duty military and the VA that he said would deliver faster, better, and far better quality care.”This new system for the VA and the military is worse than simply "behind schedule and over budget". This new system is bad to the point of being life threatening. As one doctor put it, "We took a broken system and just broke it completely."
I have seen a lot of bad implementations. In fact, I have seen mostly bad implementations. In fact...not even mostly...every implementation that I ever experienced in the last 25 years was awful...every one of them.
Why?
We ask the people what they want...we ask the current users...especially the ones in the trenches, assuming that they are the real experts. And this approach...although widely regarded as unquestionably essential...is in fact stupid.
Managers in the organization generally know nothing about how the current system is used. They know about dashboards and summary reports...usually made by other people.
Definition of a manager today is: He (or she) is a highly paid person who talks all day and emails all day and goes to meetings and is good at picking out which pie slice on the pie chart is biggest (or smallest) and then saying "This is where we need to focus."
Workers in the trenches...okay...these folks are a notch better than managers. At least they know the current system, but what does that really mean? It means they know the interface and the routine workflows and the crazy workarounds. They don't know the data structures, coding, security, hardware/network, interface design methods, and a thousand other things.
What they know is old, limited to the current system, and often arbitrary and fragmentary.
And to make things worse, they are primarily concerned with job protection. These are the people who force the vendor to mangle the out-of-box system so that it looks like and behaves like the old system. It is like having an old car with a dent on the bumper...buying a new car...and then insisting that the dealer install a dent on the new bumper.
If you are paying a vendor for a new system then why not expect...call me crazy but...a new system! Check the dictionary and see what "new" means.
So we have this built-in toxic relationship between "SMEs" and vendors and SMEs preserve their jobs and vendors charge more for changes and subsequent version upgrades. This is corrupt.
We ignore years of research when we insist on making the system fit our retro-entrenched-business. Vendors...to their credit...often evolve systems in a given industry silo...taking advantage of improvements in technology, lessons learned, and the most recent standards and best practices. Why throw that away?
Okay...this is a mostly liberal blog...but now I gotta say some things about vendors that could be considered politically incorrect.
The vendor people often fall into four distinct groups:
- Sales/Account Reps—These are "regular Americans" and they'll say anything to make the deal.
- In Charge Indians—They are "Americanized" but still able to talk to the other Indians in their own languages.
- Non-English speaking, but physically present Indians—This is the "Indian pool". They sit together and eat together and code together and smile a lot.
- Offshore Indians—We never see them or talk to them. Their salaries and benefits are probably good...by Indian standards...but probably inhuman by US standards. Either way...we really don't care and that's what bugs me. These people are coding a healthcare system while they themselves probably lack adequate healthcare!
This type of (layered and English-challenged) workforce is practically guaranteed to generate misunderstandings and cultural disconnects.
Sorry, but IT development should be totally onshore using American workers...who are trained by strong programs in colleges and community colleges and technical schools. Instead, we skim the top 2% of the talent from a country that can barely afford to feed its own people. Let that talent stay in India. They need it. We shouldn't.
(Note to President Dim-Don: Steel and aluminum and coal are not what you should be protecting.)
We all use different systems for the same thing. IT is a huge cost for companies. In an industry like insurance, everyone is basically doing the same thing. They may even be using different versions of the same system from the same vendor.
In an industry like insurance, we stand to make massive gains by achieving an economy of scale. The competitive model of unrestrained capitalism does not guarantee the best quality at the best price.
Insurance is a social lubricant. It is also a game of numbers...everything else is fluff. We are wasting our money building systems for many companies, many state-level insurance regulators, and many insurance brokerages. This is not a technical issue, but a social one.
Capitalism does not always guarantee the best. Technology...especially artificial intelligence...works best at the highest level with the best access to the largest data set. Things like insurance and healthcare don't work well in the competitive model and should be consolidated as much as possible.
